Trauma & Orthopaedic Curriculum Mapped to Simulation Options

T&O Simulation Curriculum 2013 © BOA Page 1

Trauma & Orthopaedic Curriculum Mapped to Simulation Options

To improve patient safety, many surgical/procedural, clinical and communication skills can be practiced in a simulated environment. This will also shorten the learning curve for trainees and allow them to focus their learning on their specific needs.

We aspire to provide equality of access to all trainees for opportunities in simulation, but recognise that cost and availability of some high tech facilities may limit access locally. There will be scope for a range of simulations from low to high fidelity and low to high technology. Many of these will be available locally but some will be provided at national or regional centres. This will help to provide uniformity of standards across training and orthopaedics (T&O) in the UK – deliverable and affordable for all trainees. Other benefits to the use of simulation include trainees who have 'timeout' eg maternity leave or longterm sickness, and who might be able to access these opportunities during their periods of absence, or as part of a return to practice period, to recover skills that have degraded during the period of absence; trainees not in full-time training may benefit if experiences can be accessed outwith clinical areas; and for the purpose of retraining surgeons whose skills are called into question. The mapping of particular types of simulation against the requirement of the curriculum is an on-going process and will evolve over the next three years. We have focused on integrating simulation into day to day training in surgical practice. Through our bespoke two day Training Orthopaedic Trainers programme (TOTs) we have started to teach T&O trainers simple and accessible simulation techniques to use with their trainees.

Simulation refers to any reproduction or approximation of a real event, process or set of conditions or problems for the purposes of learning or assessment. It allows trainees to focus on developing skills without the fear of making a mistake or harming a patient. Facilities of variable levels of sophistication are available, both permanently in “skills centres” and through regular course provision.

Trauma and orthopaedics has a long and established track record in the area of simulation and simulated tasks. Whilst the Training Standards Committee is anxious to embrace technology enhanced learning, our priority must be the expert supervision of trainees and appropriate preparation of trainers. We have endeavoured to explore aspects of simulation, which can be easily and inexpensively accessed by T&O trainers and trainees throughout the country. Ideally, facilities should be available close to the clinical area, with expert supervision/feedback available, and accessed in a flexible way around patient workload. Although the focus is on error avoidance and risk management, we have worked hard to ensure this is not at the expense of innovation and creativity.


The key for T&O is the preparation of both trainees and trainers. We have created a suite of courses including “Training Orthopaedic Trainers” (TOTs), “Training Orthopaedic Educational Supervisors” (TOES) and “Training Orthopaedic Clinical Supervisors” (TOCS), which have integrated concepts of simulation at various levels. Feedback and performance debriefing lie at the heart of simulation based training. T&O as a specialty is committed to getting this aspect of teaching and learning right.

BACKGROUND

Kneebone et al (2010) have developed the concept of Distributed Simulation (DS), with the underlying philosophy to provide simulation facilities that are “good enough” to engage participants and achieve learning goals, yet are low cost, accessible and can be set up in a variety of clinical or non-clinical locations.

The framework for technology enhanced learning (DOH 2011) identified six key principles recommending that technology integrated into the curriculum should:

1. Be patient centred and service driven

2. Be educationally coherent

3. Be innovative and evidence based

4. Deliver high quality educational outcomes

5. Deliver value for money

6. Ensure equity of access and quality of provision.

Technology refers to the use of “information technology” such as computers, handheld devices, simulators and simulation facilities for individual, group, multidisciplinary and interprofessional use.

Recognising the difficulties associated with mapping the entire curriculum to simulation and acknowledging the sparse evidence base for orthopaedic simulation, the TSC has developed some general recommendations targeting generic/transferable skills for trainees in the first few years of training. The early years probably derive the greatest benefit from simulation but we suggest use in later years for focused training. Once we gather data from on going educational research world wide, we will be in a better position to formulate a more detailed simulation curriculum.


SIMULATION OPPORTUNITIES

On Site Equipment Assembly (equ)

For rarer procedures where the trainee is expected to take a low level of responsibility, they should be able to gather and assemble the appropriate equipment e.g. application of halo traction or application of a pelvic external fixator.

Low Tech/Cost Options

T&O trainees have to be able to practice surgical skills in a safe environment. Novel, accessible and cheap simulation models/trainers, using recycled and reusable items, will help trainees to fully integrate simulation into learning and achieve the deliberate practice and distributed simulation to accomplish automaticity.

Examples

Drainage of an abscess, bursa or removal of a ganglion or tumour and wound debridement.

Fill the end of a latex glove with 2 – 3 ml of toothpaste and tie off to create simulated pus. Insert to balloon underneath the skin of a chicken breast/thigh/wing. The trainee can then make an incision over the abscess, cyst or ganglion and must excise it without bursting. If it does burst, they must debride the wound.

Injecting mock purulent material under the chicken breast skin can replicate the classic palpable fluctuance and ultrasound findings of an actual abscess, and it can be surgically incised and drained in a similar fashion.

Removal of malignant tumour

Insert a balloon into the muscle mass of a chicken breast. The trainee must excise the balloon with appropriate margins. No part of the glove should be visible after excision.

To simulate a foreign body the balloon can be substituted with a pebble.

Scarf Osteotomy for Hallux Valgus

Take a peeled banana and plastic knife (available in the canteen) and make the scarf osteotomy cuts. Rotate the two pieces of banana to simulate straightening of the metatarsal. Use two cocktails sticks to pin the newly straightened banana in place and cut off protruding edges of the “bone” (banana).


Arterial and Nerve Repair

Place a cut piece of string under an operating microscope, and use fine suture to repair.

Tendon Repair, Decompression, Lengthening and Transfer

Pig’s trotters offer realistic and good quality tendons on which to practice. They are readily and cheaply available.

Cementing Techniques

To be practiced using cement and a large barrelled syringe.

Debriding a Wound

A simulated wound covered with thick slough can be created on a pig trotter by excising an area of skin and then applying a layer of hydrocolloid paste (e.g. ADAPTTM, Hollister) on the denuded area. A layer of toothpaste may then be applied and covered with a piece of cling film to simulate the application of EMLA cream. A small curette is then used to debride the wound as in a human patient, after washing away the layer of toothpaste (=topical anaesthetic).

Use an orange to simulate debridement-the trainee is required to remove the peel and the white fibres (representing slough) off the orange without puncturing the inner orange itself.

Peer/Simulated Patient Skills Practice (PSP)

Some institutions have invested in the selection and training of simulated patients (SP). Whilst the educational value of such encounters with SP has been reported, they can be expensive and of limited availability. However, getting real patients to teaching meetings is a popular method and simulates an out-patients appointment. It provides an excellent opportunity to refine history and examination skills, and teaches skills in the management of the patient.

When trainees practice skills on each other, they have the unique opportunity of accessing insights into the patient experience. Application of casts and subsequent removal will help trainees to truly understand how hot a POP can become during the setting process and how threatening an oscillating saw can appear. Careful health and safety measures must be considered.


Trainees below practicing reduction of a Colles fracture taking the roles of surgeon, nurse and patient

Example of a patient with back pain

One trainee/ trainer to play the part of a patient with a large set of notes and chronic back pain for which no cause can be found, the other to assume the role of the surgeon in clinic. To explore options for handling breaking bad news:

1. I am really sorry but you have a condition for which medical science has no answer at present.

2. Your symptoms may worsen or improve over time - and if you still have symptoms in 2 years time we may have some answers..

3. Is your condition bad enough to warrant an operation? 4. Are your symptoms the same as you had on the other side? (in bilateral

problems) 5. Can you put a % figure on how much better you are after your

surgery/treatment? 6. For CRPS patients (who have a diagnosis). You have a poorly understood

problem for which there is little that we can do apart from physiotherapy. After any trauma you get swelling, pain and stiffness of your joints. CRPS patient suffer from those symptoms much more and for much longer but by 2 years most of them will abate.

These high impact simulations can be conducted whilst waiting for a delayed patient in theatre, during the lunch break in clinic or indeed any other variable period of downtime.


Bone Models (bon)

Bone models can range from expensive commercially produced synthetic bone to wooden blocks or cardboard tubes fashioned to represent bone. Some bone models would be classed as low tech/cost simulators, others are only available commercially.

Models are available but are more costly than taking two pieces of wood and gluing them together at angles to simulate a mal-union.

Cadaveric Surgery (cad)

Approach and bone fixation can be two elements of same procedure. Whilst models can simulate the bone element, fresh frozen or soft fix cadavers provide an excellent opportunity to teach soft tissue approaches. Sharing cadavers between multiple disciplines can help with cost containment.

Grouping Simulations

Some procedures comprise similar skills e.g. evacuation of haematoma, incision and drainage of abscess and excision of cyst, so simulation of each individual procedure may not be necessary. Also, many fracture fixations require similar skills, and simulation for every type may not be necessary.

Paediatrics

Obviously there are no appropriate cadaveric opportunities but the following are available:

1. Radius and ulna fracture - dry bones 2. Elbow fractures

i. supracondylar fracture dry bones with foam covering ii. lateral condyle - dry bones iii. medial epicondyle - dry bones

3. Humeral shaft and shoulder - dry bones 4. Femoral neck shaft and distal femur - simulated periosteum covered dry bone

and transparent for elastic nails 5. Tibia - dry bones for fracture fixation and osteotomy 6. Ankle for tri-plane and other complex fractures 7. Elective orthopaedics - there is a well-developed practical for corrective

osteotomy in cerebral palsy and a suitable bone for pelvic osteotomy. The surgical approaches are largely the same ones as in adult orthopaedics so trainees need to learn to do them carefully on small people. The unfamiliar


approaches (mainly anterior to the hip) can be learned on an adult cadaver.

Generally the purpose of an attachment in paediatric orthopaedics is to develop knowledge, attitudes and experience in respect of children. Trainees always do less operating in paediatric orthopaedics because paediatric orthopaedic surgeons do less operating and more clinics, plastering and injections.

Courses

A number of courses are available which include several opportunities for practicing skills in the simulated environment e.g.

1) Basic fracture fixation i) Left: learning about theatre set up using modified Playmobil ii) Right: positioning the patient safely on the operating table using Action Man

2) Basic arthroplasty 3) Basic surgical skills 4) Specialist courses including spine, hand and wrist, shoulder and elbow, foot and

ankle, pelvic and acetabular, paediatric, and fragility fractures.

Trainees and trainers should give priority to courses based on educationally sound principles rather than driven commercially. They might also consider some of the programmes which are higher risk and rarer in terms of operative opportunities e.g. spine and paediatrics. Some if these will provide the best return on investment.

Other Technology Enhanced Learning

Virtual Learning Environment


A wide variety of Virtual Learning Environments or “Learning Management Systems” are available. Regardless of which system is used, it should facilitate student registration, deliver course materials, communicate, test and track, as well as being relevant and logically organised. The barriers and facilitators to the use of the Virtual Learning Environment can be divided into two groups; issues that concern technical problems (including limited computer skills, limited access or lack of training) and issues around poor peer participation or lack of commitment. The most important facilitators to use of any VLE are flexibility, feedback and its perceived usefulness or relevance.

Touch Surgery

Touch Surgery is a mobile digital platform that outlines T&O procedures trainees to learn operative steps and be subsequently tested on the move, before and after surgery. It allows trainees to “carry out” operations step by step on their mobile touch screen device such as iPhones and iPads. It is accessible and completely free to the end user.

http://www.touch-surgery.com

Assessment

All these simulation techniques can be captured using the T&O workplace based assessment tools in current use. We have successfully used DOPs, CbD and CEX to record formative assessments/supervised learning events in trainee portfolios. This has had the added value of reinforcing the use of WBAs and bridging the theory/practice divide.

http://www.touch-surgery.com/


See below trainers and trainees completing assessments on tablets and phones after fixing fractures on bone models

AUDIT

The Training Standards Committee will plan an audit of access over the next three years. Accessibility to simulation opportunities for all trainees will be tracked, including appropriate time with trainers for exchange of feedback. Data will be sourced through

Questionnaires via the training programme director network.

Analysis of WBA activity via ISCP.

Once data has been analysed, results will be used to inform the next review of the T&O curriculum and to develop aspirational aspects into essential elements.


Applied Clinical Skills Mapped to Simulation Options A trainee must be able to demonstrate their competence in the procedures below at the appropriately

marked level and stage of training.

Competence Levels

0 = No experience expected 3 = Can manage whole but may need assistance

1 = Has observed or knows of 4 = Able to manage without assistance including potential common

complications

2 = Can manage with assistance 5 = Able to manage complex cases and their associated potential

complications

Strongly recommended for early years CT/ST1 – 4 by August 2013

Aspirational/optional or later years for focused training – by August 2013

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Trauma General

Compartment syndrome

Fasciotomy for compartment syndrome 1 4 5 cad

Measurement of compartment pressures 1 4 5 equ

Correction of malunion or other deformity 0 4 5 bon

Evacuation of haematoma 2 5 5 LT/C

Excision / ablation of ingrowing nail 1 5 5 cad

Iliac crest bone graft harvesting 2 5 5 cad

Infection

Incision and drainage of abscess 3 5 5 LT/C

Irrigation and debridement native joint for infection 1 4 5 equ

Metalware and frames

Application of external fixator (not spanning or Ilizarov) 0 4 5 bon

Application of Ilizarov frame 0 3 5 bon

Application of skeletal traction 1 5 5 equ

Application of spanning external fixator 0 4 5 bon

Removal external fixator or frame 2 5 5 equ

Removal K wires or skeletal traction 2 5 5 equ

Removal metal 2 4 5 bon

Neurovascular injuries

Arterial repair +/- graft 0 1 5 cad/ LT/C

Nerve repair 0 3 5 cad/ LT/C


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Open reduction and fixation of periprosthetic fracture 0 3 5

ORIF osteochondral fragment in joint 0 3 5 cad

Removal foreign body from skin / subcutaneous tissue 2 5 5 LT/C

Tendon repair 1 4 5 LT/C

Wound management

Free flap 0 1 1 cad

Full thickness skin graft 0 3 5 cad

Muscle flap 0 1 1 cad

Pedicle flap 0 1 1 cad

Split skin graft 0 3 5 cad

Transposition flap 0 1 1 cad

Wound closure 3 5 5 LT/C

Wound debridement 3 5 5 LT/C

Elective General (Site Non Specific)

Aspirations / injections

Aspiration / injection ankle joint 0 4 5 cad/man

Aspiration / injection elbow joint 0 4 5 cad/man

Aspiration / injection foot joint 0 4 5 cad/man

Aspiration / injection hip joint 0 3 5 cad/man

Aspiration/ injection hand and wrist 0 4 5 cad/man

Aspiration / injection knee joint 2 5 5 cad/man

Aspiration / injection shoulder joint 0 5 5 cad/man

Botulinum toxin injection - musculoskeletal 0 3 5 cad/man

Benign tumour excision (not exostosis) 0 3 5 LT/C

Biopsy bone - needle 0 3 5 LT/C

Biopsy bone - open 0 3 5 LT/C

Currettage pinsites 0 5 5

Cyst bone curettage +/- bone graft 0 3 5 LT/C

Distraction lengthening of bone upper limb 0 2 5 equ

Endoprosthetic replacement for malignant bone tumour - not femur /

humerus / tibia 0 1 5

Epiphysiodesis 0 1 5

Exostosis / osteochondroma excision 0 3 5

Injection of bone cyst 0 1 5

Malignant tumour excision 0 1 5 LT/C

Nerve decompression / neurolysis 2 4 5

Osteomyelitis excision including sequestrectomy 0 3 5 LT/C

Soft tissue procedures

Biopsy soft tissue 0 3 5 LT/C

Bursa excision 0 4 5 LT/C

Ganglion excision 0 4 5 LT/C


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Muscle biopsy 0 4 5 LT/C

Release contracture joint 0 3 5

Synovectomy 0 3 5 cad/ LT/C

Tendon decompression 0 4 5 LT/C

Tendon lengthening 0 3 5 LT/C

Tendon transfer 0 3 5 LT/C

Tenodesis 0 3 5 DIY

Amputations

Forequarter amputation 0 1 5 eqi

Above elbow amputation 0 2 5 cad

Below elbow amputation 0 2 5 cad

Finger amputation 0 4 5 cad

Hindquarter amputation 1 1 5 cad

Above knee amputation 0 3 5 cad

Through knee amputation 0 1 5 eqi

Below knee amputation 1 4 4 cad

Through ankle amputation 0 1 5 equ

Hindfoot amputation 0 2 5 cad

Midfoot amputation 0 1 5 cad

Toe amputation 0 4 5 cad


Applied Clinical Skills: Spine A trainee must be able to demonstrate their competence in the procedures below at the appropriately


Competence Levels



complications


complications

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Trauma Spine

Cervical Spine

Anterior column reconstruction cervical spine 0 1 5 cad,ani,equ

Anterior fixation fracture / dislocation cervical spine 0 1 5 cad,ani,equ

Application halo / tong traction cervical spine 0 1 5 equ, LT/C

MUA fracture / dislocation cervical spine 0 1 5 cad,ani,equ,bon

Non-classifiable cervical spine trauma procedure 0 1 5 cad,ani,equ,bon

Posterior column reconstruction cervical spine 0 1 5 cad,ani,equ,bon

Posterior fixation fracture / dislocation cervical spine 0 1 5 cad,ani,equ,bon

Brachial Plexus

Exploration / repair / grafting brachial plexus 0 1 5 cad

Exploration of brachial plexus 0 1 5 cad

Repair +/- grafting brachial plexus 0 1 5 cad

Thoracic Spine

Anterior column reconstruction thoracic spine 0 1 5 cad,ani,equ,bon

Anterior decompression / fixation thoracic spine 0 1 5 cad,ani,equ,bon

Anterior decompression thoracic spine 0 1 5 cad,ani,equ,bon

Posterior column reconstruction thoracic spine 0 1 5 cad,ani,equ,bon

Posterior decompression / fixation thoracic spine 0 1 5 cad,ani,equ,bon

Posterior decompression thoracic spine 0 1 5 cad,ani,equ,bon

Lumbar Spine

Anterior column reconstruction lumbar spine 0 1 5 cad,ani,equ,bon

Anterior decompression / fixation lumbar spine 0 1 5 cad,ani,equ,bon

Anterior decompression lumbar spine 0 1 5 cad,ani,equ,bon

Posterior column reconstruction lumbar spine 0 1 5 cad,ani,equ,bon

Posterior decompression / fixation lumbar spine 0 1 5 cad,ani,equ,bon

Posterior decompression lumbar spine 0 1 5 cad,ani,equ,bon


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Elective Spine

Cervical Spine

Anterior column reconstruction cervical spine 0 1 5 cad,ani,equ,bon

Cervical disc replacement 0 1 5 cad,ani,equ,bon

Cervical laminectomy 0 1 5 cad,ani,equ,bon

Cervical laminoplasty 0 1 5 cad,ani,equ,bon

Cervical vertebrectomy for myelopathy 0 1 5 cad,ani,equ,bon

Excision hemivertebra 0 1 5 cad,ani,equ,bon

Fixation and fusion procedures

Anterior decompression +/- fixation / fusion (C2 - C7) 0 1 5 cad,ani,equ,bon

Atlantoaxial fixation +/- fusion 0 1 5 cad,ani,equ,bon

C1 pedicle screws and C2 fusion 0 1 5 cad,ani,equ,bon

Occipital / cervical / thoracic fusion 0 1 5 cad,ani,equ,bon

Occipital cervical fusion 0 1 5 cad,ani,equ,bon

Occipito-cervical fusion +/- fixation 0 1 5 cad,ani,equ,bon

Posterior decompression +/- fixation / fusion (C2 - C7) 0 1 5 cad,ani,equ,bon

Transarticular screws C1/C2 0 1 5 cad,ani,equ,bon

Investigations and injections

Biopsy cervical spine 0 1 5 cad,ani,equ,bon

Discogram 0 1 5 cad,ani,equ,bon

Epidural 0 1 5 cad,ani,equ,bon

Nerve root / facet joint injection cervical spine 0 1 5 cad,ani,equ,bon

Osteotomy for spine sagittal plain imbalance 0 1 5 cad,ani,equ,bon

Posterior column reconstruction cervical spine 0 1 5 cad,ani,equ,bon

Revision cervical discectomy 0 1 5 cad,ani,equ,bon

Thoracic outlet obstruction

Excision cervical / 1st rib 0 1 5 cad,ani,equ,bon

Thoracic outlet release (not excision cervical / 1st rib) 0 1 5 cad,ani,equ,bon

Thoracic Spine

Anterior column reconstruction thoracic spine 0 1 5 cad,ani,equ,bon

Costoplasty 0 1 5 cad,ani,equ,bon


Fixation or fusion procedures

Anterior decompression +/- fixation / fusion 0 1 5 cad,ani,equ,bon

Posterior decompression +/- fixation / fusion 0 1 5 cad,ani,equ,bon


Biopsy thoracic spine 0 1 5 cad,ani,equ,bon


Kyphosis correction

Kyphoplasty corpectomy 0 1 5 cad,ani,equ,bon

Kyphosis correction - anterior and posterior 0 1 5 cad,ani,equ,bon

Kyphosis correction - anterior only 0 1 5 cad,ani,equ,bon

Posterior column reconstruction thoracic spine 0 1 5 cad,ani,equ,bon

Scoliosis correction - anterior release +/- instrumentation 0 1 5 cad,ani,equ,bon


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Scoliosis correction - posterior fusion +/- instrumentation 0 1 5 cad,ani,equ,bon

Scoliosis correction

Anterior release + posterior fusion and instrumentation for

scoliosis 0 1 5

cad,ani,equ,bon

Growing rods for scoliosis 0 1 5 cad,ani,equ,bon

Lengthening of growing rods for scoliosis 0 1 5 cad,ani,equ,bon

Localiser cast for scoliosis 0 1 5 cad,ani,equ,bon

Scoliosis correction - anterior release +/- instrumentation 0 1 5 cad,ani,equ,bon

Scoliosis correction - posterior fusion +/- instrumentation 0 1 5 cad,ani,equ,bon

Thoracic disc replacement 0 1 5 cad,ani,equ,bon

Vertebroplasty 0 5 cad,ani,equ,bon

Thoracoscopic spinal procedures +/- instrumentation 0 1 5 cad,ani,equ,bon

Lumbar Spine

Anterior column reconstruction lumbar spine 0 1 5 cad,ani,equ,bon

Decompression lumbar spine without fusion (not discectomy

alone) 0 2 5

cad,ani,equ,bon

Discectomy open / micro 0 2 5 cad,ani,equ,bon


Fixation and fusion procedures cad,ani,equ,bon

ALIF 0 1 5 cad,ani,equ,bon

Decompression lumbar spine with fusion +/- fixation 0 1 5 cad,ani,equ,bon

PLIF 0 1 5 cad,ani,equ,bon

TLIF 0 1 5 cad,ani,equ,bon


Caudal epidural injection 0 3 5 cad,ani,equ,bon


Epidural 1 3 5 PSP,man

Facet joint injection lumbar spine 0 1 5 cad,ani,equ,bon

Nerve root injection lumbar spine 0 1 5 cad,ani,equ,bon

Lumbar disc replacement 0 1 5 cad,ani,equ,bon

Lumbar spine - dynamic neutralisation system 0 1 5 cad,ani,equ,bon

Osteotomy for spine sagittal plain imbalance 0 1 5 cad,ani,equ,bon

Posterior column reconstruction lumbar spine 0 1 5 cad,ani,equ,bon

Revision lumbar discectomy 0 1 5 cad,ani,equ,bon

Vertebroplasty 0 1 5 cad,ani,equ,bon


Applied Clinical Skills: Shoulder A trainee must be able to demonstrate their competence in the procedures below at the appropriately


Competence Levels



complications


complications

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Trauma Shoulder

Clavicle

ORIF clavicle fracture 0 4 5 bon/cad

ORIF non-union clavicle fracture 0 3 5 bon/cad

SC joint dislocation closed / open reduction 0 3 5 bon/cad

SC joint instability/open stabilisation 0 2 5 bon/cad

Shoulder

Acromioclavicular joint dislocation acute ORIF 0 3 5 bon/cad

Anterior dislocation shoulder

Anterior dislocation shoulder closed reduction 2 5 5 PSP

Anterior dislocation shoulder open reduction +/- fixation 0 3 5 bon/cad

Fracture proximal humerus

Fracture proximal humerus hemiarthroplasty 0 3 5 bon/cad

Fracture proximal humerus interlocking IM nail 0 3 5 bon/cad

Fracture proximal humerus ORIF 0 3 5 bon/cad

Glenoid fracture ORIF 0 2 5 -

Irrigation and debridement native joint for infection - shoulder 0 2 5 -

Posterior dislocation shoulder

Posterior dislocation shoulder closed reduction 0 3 5 PSP

Posterior dislocation shoulder open reduction +/- fixation 0 3 5 bon/cad

Scapula fracture ORIF 0 2 5 bon/cad

Humerus

Fracture diaphysis humerus

Fracture diaphysis humerus non-operative 1 4 5 PSP

Non-union ORIF +/- bone grafting 0 3 5 bon/cad

Fracture diaphyseal humerus application of external fixator 0 3 5 bon/cad

Fracture diaphyseal humerus non-union - ORIF +/- bone

grafting 0 3 5

bon/cad

Fracture diaphysis humerus IM nailing 0 4 5 bon/cad


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Fracture diaphysis humerus ORIF plating 0 4 5 bon/cad

Elective Shoulder

Clavicle

Osteotomy and internal fixation of clavicle malunion 0 2 5

Shoulder

Arthroscopic procedures man

Arthroscopic arthrolysis for capsulitis of shoulder 0 4 5 man

Arthroscopic biceps tenodesis 0 2 5 man

Arthroscopic subacromial decompression 0 4 5 man

Arthroscopic removal loose body - shoulder man

Arthroscopy diagnostic - shoulder 0 4 5 man

Capsular / rotator cuff repair man

Anterior repair for instability arthroscopic 0 2 5 man

Anterior repair for instability open including capsular shift 0 2 5 man

Posterior repair for instability including capsular shift 0 2 5 man

Rotator cuff repair (arthroscopic) +/- acromioplasty 0 2 5 man

Rotator cuff repair (open) +/- acromioplasty 0 2 5 man

MUA shoulder 0 4 5 PSP

Shoulder arthrodesis 0 1 5 -

Shoulder arthroplasty

Hemiarthroplasty shoulder (elective) 0 2 5 bon/cad

Resurfacing hemiarthroplasty of shoulder 0 2 5 bon/cad

Reverse polarity (inverse) shoulder replacement 0 2 5 bon/cad

Shoulder replacement revision 0 1 5 bon/cad

Total shoulder replacement 0 2 5 bon/cad

Shoulder girdle procedures

Acromioclavicular joint excision - arthroscopic / open / lateral

clavicle 0 2 5

bon/cad

Acromioclavicular joint reconstruction (eg Weaver Dunn) 0 2 5 bon/cad

Acromioplasty open 0 3 5 bon/cad

Latarjet procedure 0 2 5 bon/cad

Levator scapulae transfer for trapezius palsy 0 1 5 bon/cad

Scapulothoracic fusion 0 1 5 bon/cad

Humerus

Endoprosthetic replacement for malignant bone tumour -

humerus 0 1 5

-


Applied Clinical Skills: Elbow A trainee must be able to demonstrate their competence in the procedures below at the appropriately


Competence Levels



complications


complications

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Trauma Elbow

Elbow

Application of spanning external fixator 0 2 5 bon/equ

Capitellum ORIF 0 3 5 bon/cad

Coronoid fractures

Coronoid fracture ORIF 0 2 5 bon

Dislocated elbow +/- fracture:

Dislocated elbow +/- fracture closed reduction 0 4 5 PSP

Dislocated elbow +/- fracture open reduction +/- fixation 0 3 5 bon/cad

Intraarticular distal humerus fracture ORIF 0 4 5 bon/cad

Irrigation and debridement native joint for infection – elbow 0 3 bon/cad

Lateral condyle fracture ORIF 0 4 5 bon/cad

Medial condyle / epicondyle fracture MUA / percutaneous wire / ORIF 0 4 5 bon/cad

Olecranon fracture ORIF 0 4 5 bon/cad

Radial head / neck fracture

Radial head / neck fracture ORIF 0 3 5 bon/cad

Radial head excision 0 4 5 bon/cad

Radial head replacement for fracture 0 4 5 bon/cad

Supracondylar elbow fracture bon

Supracondylar elbow fracture MUA +/- percutaneous wires 0 4 5 PSP

Supracondylar elbow fracture open reduction 0 4 5 bon/cad

Tendon repairs

Repair of distal biceps tendon rupture 0 3 5 cad

Forearm


Fracture shaft radius / ulna:

Fracture shaft radius / ulna IM nailing 0 3 5 bon/cad

Fracture shaft radius / ulna MUA & POP 0 4 5 PSP

Fracture shaft radius / ulna ORIF 0 4 5 bon/cad


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Galeazzi fracture ORIF 0 4 5 bon/cad

Monteggia fracture ORIF 0 4 5 bon/cad

Elective Elbow

Elbow

Arthrolysis elbow (open/arthroscopic) 0 2 5 man

Arthroscopy elbow diagnostic 0 2 5 man

Arthoscopy elbow therapeutic 0 2 5 man

Arthrotomy elbow 0 4 5 man

Excision radial head +/- synovectomy 0 2 5 man

OK procedure 0 2 5 man

Tennis / golfer elbow release 0 4 5 cad

Total elbow replacement

Total elbow replacement 0 2 5 bon/cad

Total elbow replacement - aseptic revision 0 1 4 bon/cad

Total elbow replacement for trauma 0 1 5 bon/cad

Total elbow replacement revision 1st stage 0 1 4 bon/cad

Total elbow replacement revision 2nd stage 0 1 4 bon/cad

Ulnar nerve decompression / transposition 0 4 5 bon/cad

Forearm

Forearm malunion correction or other deformity 0 1 5 bon/cad


Applied Clinical Skills: Hand A trainee must be able to demonstrate their competence in the procedures below at the appropriately


Competence Levels



complications


complications

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Trauma Hand

Wrist

Fracture distal radius:

Fracture distal radius – closed non-op 3 5 5 PSP

Fracture distal radius external fixation 1 4 5 bon

Fracture distal radius MUA & percutaneous wires 3 5 5 PSP

Fracture distal radius ORIF 1 4 5 bon/cad

Application of spanning external fixator 1 4 5 bon/cad

Arterial repair - wrist 0 1 5 cad/ LT/C

Vein repair – wrist 0 1 5 cad/ LT/C

Carpal fracture / dislocation:

Carpal fracture / dislocation MUA & percutaneous wires 0 3 5 bon

Carpal fracture / dislocation MUA & POP 0 3 5 PSP

Carpal fracture / dislocation ORIF 0 3 5 bon

Irrigation and debridement prosthesis for infection – wrist 0 2 5 ani

Nerve repair - wrist 0 3 5 LT/C

Replantation of hand 0 0 1 cad

Revascularisation of hand 0 0 1 cad

Scapho-lunate ligament reconstruction 0 2 5 cad

Scaphoid fracture:

Scaphoid fracture non-operative 2 3 5 PSP

Scaphoid fracture MUA & percutaneous wires 0 2 5 bon/cad

Scaphoid fracture non-union ORIF +/- graft (excluding vascularised graft) 0 2 5 bon/cad

Scaphoid fracture non-union using vascularised graft 0 2 5 bon/cad

Scaphoid fracture ORIF 0 2 5 bon/cad

Hand

1st ray fracture / dislocation

1st ray fracture / dislocation external fixation 0 2 5 bon/cad


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1st ray fracture / dislocation MUA & percutaneous wires 0 3 5 bon/cad

1st ray fracture / dislocation MUA & POP 2 4 5 PSP

1st ray fracture / dislocation ORIF 0 2 5 bon/cad

Carpal fracture / dislocation

carpal fracture / dislocation non-op 0 3 5 bon/cad/PSP

carpal fracture / dislocation MUA & percutaneous wires 0 3 5 bon/cad

carpal fracture / dislocation MUA & POP 0 3 5 bon/cad/PSP

carpal fracture / dislocation ORIF 0 2 5 bon/cad

5th ray fracture / dislocation

5th ray fracture / dislocation external fixation 0 2 5 PSP

5th ray fracture / dislocation MUA & percutaneous wires 0 3 5 bon

5th ray fracture / dislocation MUA & POP 2 3 5 PSP

5th ray fracture / dislocation ORIF 0 2 5 bon/cad

Excision / ablation of ingrowing nail 2 5 5 man

Finger tip reconstruction

Finger tip reconstruction - advancement flap 0 3 5 cad

Finger tip reconstruction - cross finger flap 0 3 5 cad

Finger tip reconstruction - homodigital neurovascular island flap 0 2 5 cad

Finger tip terminalisation 2 5 5 cad

Nail bed repair 2 4 5 cad

Hand compartment syndrome decompression 2 4 5 cad

Infection

High pressure injection injuries 0 2 5 cad

Infection hand drainage (not tendon sheath) 1 3 5 cad

Infection tendon sheath drainage 1 3 5 cad

IPJ fracture / dislocation (PIPJ and DIPJ):

IPJ fracture / dislocation external fixator 1 2 5 bon/cad

IPJ fracture / dislocation MUA & percutaneous wires 1 4 5 bon/cad

IPJ fracture / dislocation MUA +/- POP 2 4 5 PSP

IPJ fracture / dislocation ORIF 0 2 5 bon/cad

Ligament repair

Ligament repair hand excluding thumb MCPJ ulnar collateral ligament 0 2 5 cad

Thumb MCPJ ulnar collateral repair 1 5 5 cad

MCPJ fracture / dislocation

MCPJ fracture / dislocation external fixator 0 2 5 bon/cad

MCPJ fracture / dislocation MUA & percutaneous wires 1 4 5 bon/cad

MCPJ fracture / dislocation MUA +/- POP 1 4 5 PSP

MCPJ fracture / dislocation ORIF 0 3 5 bon/cad

Metacarpal fracture (not 1st or 5th) non-op 2 4 5 PSP

Metacarpal fracture (not 1st or 5th) MUA & percutaneous wires 1 4 5 bon/cad

Metacarpal fracture (not 1st or 5th) MUA +/- POP 2 5 5 PSP


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Metacarpal fracture (not 1st or 5th) ORIF 0 3 5 bon/cad

Metacarpal fracture (not 1st or 5th) external fixation 0 3 5 bon/cad

Neurovascular injuries

Arterial repair +/- graft hand / digit 0 1 2 LT/C/cad

Nerve repair hand / digit 1 4 5 LT/C/cad

Revascularisation finger 0 1 2 LT/C/cad

Vein repair +/- graft hand / digit 0 1 2 LT/C/cad

Phalangeal fracture non-op 2 4 5 PSP

Phalangeal fracture MUA & percutaneous wires 1 4 5 bon

Phalangeal fracture MUA +/- POP 2 4 5 PSP

Phalangeal fracture ORIF 0 3 5 bon

Removal foreign body from skin / subcutaneous tissue 3 5 5 ani

Replantation finger 0 1 2 cad

Skin graft

Free flap 0 1 5 cad

Full thickness skin graft 2 3 5 cad

Pedicle flap 0 2 5 cad

Reversed radial forearm flap 0 2 3 cad

Split skin graft 2 4 5 cad

Transposition flap 0 2 3 cad

Tangential excision of hand burns 0 1 2 cad

Tendon repair

Spaghetti wrist 0 2 5 cad

Tendon repair extensor 2 5 5 ani/ LT/C

Tendon repair flexor zone 1 0 2 5 cad

Tendon repair flexor zone 2 0 2 5 cad

Tendon repair flexor zone 3-5 0 4 5 cad

Wound closure

Delayed primary or secondary 1 4 5 LT/C

Wound debridement 1 4 5 LT/C

Elective Hand

Wrist

Arthrodesis wrist (includes partial arthrodesis) 0 3 5 cad

Arthroscopy wrist 0 2 5 man/cad

Carpal tunnel decompression 3 5 5 cad

De Quervain's decompression 1 5 5 cad

Decompression / synovectomy tendons 0 3 5 cad

Denervation wrist 0 3 5 cad

Excision distal ulna 0 4 5 cad

Ganglion excision at wrist 2 5 5 LT/C


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Proximal row carpectomy 0 2 5 cad

Radial shortening 0 2 5 cad

Surgery for chronic carpal instability 0 2 5 cad

TFCC

Repair TFCC - arthroscopic 0 2 5 cad

Repair TFCC - open 0 2 5 cad

Ulna shortening 0 3 5 cad

Ulnar nerve decompression at wrist 0 3 5 cad

Wrist arthroplasty 0 2 5 cad

Hand

Carpal tunnel decompression 3 5 5 cad

Congenital hand operation

Congenital hand operation - clinodactyly 0 1 4 -

Congenital hand operation - complex reconstruction of congenital hand

deformity 0 1 2

-

Congenital hand operation - camptodactyly 0 1 2 -

Congenital hand operation - correction of radial club hand 0 1 2 -

Congenital hand operation - lengthening procedures 0 1 2 -

Congenital hand operation - removal supernumerary digits 0 1 3 -

Congenital hand operation - separation of syndactyly 0 1 3 -

Dupuytren's contracture operation

Dupuytrens contracture operation - dermofasciectomy 0 2 5 cad

Dupuytren's contracture operation - primary multiple digits 0 3 5 cad

Dupuytren's contracture operation - primary single digit 0 3 5 cad

Dupuytren's contracture operation - recurrent multiple digits 0 2 5 cad

Dupuytren's contracture operation - recurrent single digit 0 2 5 cad

Excision synovial cyst 0 3 5 LT/C

Finger malunion correction or other deformity 0 2 5 cad

Fusion of MCPJ or IPJ 0 3 5 cad

MCPJ replacement 0 2 5 cad

PIPJ replacement - hand (other) 0 2 5 cad

PIPJ replacement - hand (silastic) 0 2 5 cad

Soft tissue reconstruction hand 0 2 5 cad

Synovectomy 0 3 5 cad

Tendon procedures

Tendon graft hand 0 2 5 cad

Tendon transfer hand 0 2 5 cad

Tenolysis hand tendon 0 2 5 cad


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Tenosynovectomy 0 2 5 cad

Trapezium excision or replacement 0 3 5 cad

Trigger finger release 2 5 5 cad

Trigger thumb release 1 5 5 cad


Applied Clinical Skills: Hip A trainee must be able to demonstrate their competence in the procedures below at the appropriately


Competence Levels



complications


complications

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Trauma Hip

Pelvis

Acetabular fracture ORIF 0 2 4 bon/cad

Pelvic fracture:

Pelvic fracture external fixator application 1 3 5 bon/equ

Pelvic fracture ORIF 0 2 5 bon/cad

Sacroiliac joint percutaneous screw fixation 0 1 5 bon/cad

Sacrum ORIF 0 1 4 bon/cad

Hip

Dislocated hip

Dislocated hip (no prosthesis) - closed reduction 1 4 5 PSP

Dislocated hip (no prosthesis) - open reduction +/- fixation 0 3 5 bon/cad

Dislocated hip hemiarthroplasty - closed reduction 2 4 5 PSP

Dislocated hip hemiarthroplasty - open reduction 0 4 5 bon/cad

Dislocated total hip replacement - closed reduction 2 4 5 PSP

Dislocated total hip replacement - open reduction 0 4 5 bon/cad

Extracapsular fracture

Extracapsular fracture CHS / DHS 3 5 5 bon

Extracapsular fracture intramedullary fixation 0 5 5 bon

Extracapsular fracture other fixation 0 4 5 bon

Intracapsular fracture

Intracapsular fracture bipolar hemiarthroplasty 0 5 5 bon

Intracapsular fracture hemiarthroplasty excluding bipolar 2 5 5 bon

Intracapsular fracture internal fixation 1 5 5 bon

Intracapsular fracture THR 1 4 5 bon

Irrigation and debridement native joint for infection - hip 0 4 5 cad/eqi

Irrigation and debridement prosthesis for infection - hip 0 4 5 cad/eqi


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Periprosthetic fracture of hip

Open reduction and fixation of periprosthetic fracture - hip 0 3 5 bon/cad

Revision THR for periprosthetic fracture of hip 0 2 5 bon/cad

Femur

Diaphyseal fracture

Diaphyseal femur fracture application of external fixator 0 3 5 bon

Diaphyseal femur fracture intramedullary nailing 0 5 5 bon

Diaphyseal femur fracture plate/screw fixation 0 4 5 bon

Diaphyseal femur fracture spica cast application 0 3 3 PSP


Femoral non-union

Femoral non-union (application of frame) +/- bone grafting 0 2 5 bon/cad

Femoral non-union (without frame) +/- bone grafting 0 2 5 bon/cad

Reconstruction of avulsed proximal hamstrings 0 1 5 bon/cad

Subtrochanteric fracture

Subtrochanteric fracture intramedullary fixation 0 4 5 bon

Subtrochanteric fracture plate/screw fixation 0 3 5 bon

Elective Hip

Pelvis

Sacrococcygeal joint injection / MUA 0 3 5 cad

Sacro-iliac joint injection 0 3 5 cad

Hip

Adductor tenotomy - hip 0 3 5 cad

Arthrodesis hip 0 2 5 bon/cad

Arthroscopy hip - diagnostic 0 1 5

Arthroscopy hip - therapeutic 0 1 5

Arthrotomy hip 0 3 5 cad

Aspiration / injection hip joint 0 3 5 cad

Excision arthroplasty hip (e.g. Girdlestone) 0 3 5 cad

Femoral head AVN

Core decompression of femoral head for AVN 0 3 5 cad

Vascular graft femoral head for AVN 0 2 3 cad

Femeroacetabular impingement

Open hip debridement for femeroacetabular impingement

syndrome 0 1 4

cad

Iliopsoas release / lengthening 0 2 5 cad

Osteotomy pelvis - not for DDH 0 1 3 cad


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Revision THR

1 stg of 2 stg rev infected THR - removal of prosthesis +/-insertion

of cement spacer / antibiotic beads 0 2 5

bon/cad

2 stg of 2 stg rev infected THR - removal of spacer/beads 0 2 5 bon/cad

Single stage revision THR acetabular component 0 2 5 bon/cad

Single stage revision THR both components 0 2 5 bon/cad

Single stage revision THR femoral component 0 2 5 bon/cad

Total Hip Replacement

THR cemented 1 4 5 bon/cad

THR hybrid 1 4 5 bon/cad

THR surface replacement 1 2 5

THR uncemented 1 4 5 bon/cad

Femur

Endoprosthetic replacement for malignant bone tumour - femur 1 2 4 bon/cad

Femoral malunion correction or other deformity 0 2 4 bon/cad

Osteotomy corrective (not for DDH) 0 2 4 bon/cad


Applied Clinical Skills: Knee A trainee must be able to demonstrate their competence in the procedures below at the appropriately


Competence Levels



complications


complications

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Trauma Knee

Knee

Acute arthroscopy for knee trauma 0 3 5 man

Application of spanning external fixator 0 2 5 bon

Intraarticular fracture distal femur ORIF 0 3 5 bon

Irrigation and debridement native joint for infection (open or arthroscopic) -

knee 1 4 5

cad

Irrigation and debridement prosthesis for infection - knee 1 4 5 cad

Knee MUA +/- POP 2 5 5 PSP

Patella fracture

Patella dislocation closed reduction +/- open repair 1 4 5 cad

Patella fracture ORIF 0 4 5 bon

Patellectomy 0 4 5 cad

Periprosthetic fracture of knee

Open reduction and fixation of periprosthetic fracture - knee 0 2 5 bon/cad

Revision TKR for periprosthetic fracture of knee 0 3 5 bon/cad

Soft tissue repair

Acute ligament repair 0 3 5 LT/C /cad

Patella tendon repair 0 4 5 LT/C /cad

Quadriceps tendon repair 0 4 5 LT/C /cad

Supracondylar fracture (not intraarticular)

Supracondylar fracture (not intraarticular) DCS / blade plate etc 0 4 5 bon

Supracondylar femur fracture (not intraarticular) external fixation 0 4 5 bon

Supracondylar femur fracture (not intraarticular) Intramedullary fixation 0 4 5 bon

Supracondylar femur fracture (not intraarticular) MUA & POP 0 4 5 PSP


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Tibial plateau fracture

Repair of tibial spine 0 3 5 bon

Tibial plateau fracture arthroscopically assisted fixation 0 2 5 cad

Tibial plateau fracture ORIF with plates & screws 0 4 5 bon

Tibial plateau fracture treatment with circular frame 0 2 4 bon

Tibia & Fibula

Diaphyseal tibial fracture

Diaphyseal tibial fracture external fixation (including frame) 1 3 5 bon

Diaphyseal tibial fracture intramedullary nailing 1 4 5 bon

Diaphyseal tibial fracture MUA & POP 1 5 5 PSP

Tibial shaft plating 0 3 5 cad


Tibial non-union

Tibial non-union circular frame management 0 2 3 eqi

Tibial non-union intramedullary nailing +/- bone grafting 0 2 3 bon

Tibial non-union ORIF +/- bone grafting 0 2 3 bon

Elective Knee

Knee

Arthroscopic partial meniscectomy 1 5 5 man/cad

Arthroscopic procedures

Arthroscopic excision of Hoffa's fat pad 0 4 5 man/cad

Arthroscopic lateral release 0 4 5 man/cad

Arthroscopic menisectomy 0 5 5 man/cad

Arthroscopic removal loose bodies knee 0 4 5 man/cad

Arthroscopic synovectomy 0 3 5 man/cad

Arthroscopy knee diagnostic 1 5 5 man/cad

Meniscal repair (arthroscopic) 0 3 5 man/cad

Aspiration / injection knee joint 2 5 5 man/cad

Below knee amputation 1 4 5 cad

Cartilage regeneration procedures

Abrasion arthroplasty / microfracture - knee 0 2 5 man/cad

Mosaicplasty - knee 0 2 4 man/cad

Osteochondral allografting - knee 0 2 4 man/cad

Autologous chondrocyte implantation 0 2 5 man/cad

Knee arthroplasty

Patella resurfacing alone 0 1 3 LT/C

Patello-femoral joint replacement 0 1 3 bon

TKR 1 4 5 bon/cad

Unicompartmental knee replacement 0 3 5 bon


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MUA knee 2 4 5 PSP

Osteotomy distal femoral 0 2 4 bon/cad

Osteotomy proximal tibial 0 2 5 bon/cad

Patella realignment 0 3 5 bon/cad

Patella tendon decompression (open / arthroscopic) 0 3 5 cad

Release contracture knee 0 2 4 cad

Revision TKR

1 stg of 2 stg rev infected TKR - removal of prosthesis +/- insertion of

cement spacer / antibiotic beads 0 2 5

bon/cad

2 stg of 2 stg rev infected TKR - removal of spacer/beads 0 2 5 bon/cad

Revision TKR for periprosthetic fracture of knee 0 2 5 bon/cad

Single stage revision TKR 0 2 5 bon/cad

Soft tissue reconstruction

ACL reconstruction - arthroscopic 0 2 5 man/cad

ACL reconstruction - open 0 2 5 man/cad

Reconstruction of posterolateral corner of knee 0 2 5 man/cad

PCL reconstruction 0 2 5 man/cad

Revision ACL reconstruction 0 1 5 man/cad

TKR 1 4 5 bon/cad

Tibia & Fibula

Endoprosthetic replacement for malignant bone tumour - tibia 1 2 3 bon/cad

Tibia or fibula malunion correction or other deformity 0 2 4 bon/cad

Tibial lengthening 0 1 2 bon/cad


Applied Clinical Skills: Foot and Ankle A trainee must be able to demonstrate their competence in the procedures below at the appropriately


Competence Levels



complications


complications

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Trauma Foot and Ankle

Ankle

Ankle fracture / dislocation

Ankle fracture / dislocation MUA & POP 3 5 5 PSP

Ankle fracture / dislocation ORIF 3 5 5 bon/cad

Application of spanning external fixator 0 2 5 bon/cad

Irrigation and debridement native joint for infection - ankle 1 3 5 cad

Irrigation and debridement prosthesis for infection - ankle 0 2 5 cad

Pilon fracture

Pilon fracture ex-fix 0 2 5 bon/cad

Pilon fracture ORIF 0 2 5 bon/cad

Pilon fracture treatment with circular frame 0 2 5 bon/cad

Foot

Amputation toe / ray for trauma 0 3 5 cad

Calcaneal fracture

Calcaneal fracture ex-fix 0 2 5 bon

Calcaneal fracture ORIF 0 2 5 cad

Metatarsal fracture ORIF 0 2 5 bon

Phalangeal fracture MUA +/- K wire +/- ORIF 1 3 5 bon

Removal foreign body from skin / subcutaneous tissue 2 5 5 LT/C

Talar subtalar or midtarsal fracture / dislocation

Lisfranc fracture ORIF 0 3 5 bon

Midtarsal fracture / dislocation ORIF 0 3 5 bon

Subtalar fracture / dislocation ORIF 0 3 5 bon

Talar fracture / dislocation ORIF 0 3 5 bon

Talectomy 0 3 5 bon

Tarsometatarsal arthrodesis 0 2 5 bon


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Achilles tendon repair 1 4 5 cad

Tendon repair in foot 0 3 5 LT/C

Elective Foot and Ankle

Ankle

Arthrodesis ankle (open /arthroscopic) 0 2 5 bon/cad

Arthroplasty ankle 0 2 4 bon/cad

Arthroscopic procedures

Arthrodesis ankle - arthroscopic 0 1 4 man/cad

Arthroscopy ankle diagnostic 0 2 5 man/cad

Arthroscopy ankle therapeutic 0 2 4 man/cad

Arthrotomy ankle 0 2 5 cad

Aspiration / injection ankle joint 0 3 5 man/cad

Ligament repair / reconstruction

Ankle - lateral ligament reconstruction 0 2 5 cad

Ankle - lateral ligament repair 0 2 5 cad

Ankle - medial ligament repair 0 2 5 cad

Pantalar arthrodesis 0 2 5 cad

Tendon procedures

Decompression tendons at ankle 0 2 5 cad

Gastrocnemius lengthening 0 2 4 cad

Tendo achilles reconstruction for neglected rupture 0 2 4 cad

Tendo-achilles lengthening 0 2 4 cad

Foot

Akin osteotomy of proximal phalanx great toe 0 2 5 bon/cad

Amputation toe / ray 0 3 5 bon/cad

Ankle chielectomy 0 2 5 bon/cad

Arthrodesis procedures

Ankle 0 2 5 bon/cad/ LT/C

Hindfoot 0 2 5 bon/cad/ LT/C

Midtarsal 0 2 5 bon/cad/ LT/C

Forefoot and toes 0 2 5 bon/cad/ LT/C

Aspiration / injection foot joint 0 3 5 bon/cad/ LT/C

Calcaneal osteotomy 0 2 5 bon/cad/ LT/C

Excision Haglund's deformity 0 2 5 bon/cad/ LT/C

Excision of accessory navicular 0 2 5 bon/cad/ LT/C

Excision of tarsal coalition 0 2 5 bon/cad/ LT/C

First metatarsal osteotomy

First metatarsal osteotomy - basal 0 2 5 bon


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First metatarsal osteotomy - distal 0 3 5 bon/cad

First metatarsal osteotomy – other 0 3 5 bon/cad

First metatarsal osteotomy - Scarf 0 3 5 bon/cad

First MTPJ procedures

First MTPJ arthrodesis 0 3 5 bon/cad

First MTPJ cheilectomy 0 3 5 bon/cad

First MTPJ excision arthroplasty 0 3 5 bon/cad

First MTPJ replacement arthroplasty (silastic or other) 0 2 4 bon/cad

First MTPJ soft tissue correction 0 3 5 bon/cad

Foot malunion correction or other deformity 0 2 4 bon/cad

Forefoot arthroplasty (Mann Thompson / Stainsby / Other 0 2 5 bon/cad

Ingrowing toenail operation 2 5 5 bon/cad

Lesser metatarsal osteotomy 0 2 5 bon/cad

Lesser toe excision part/all phalanx 0 3 5 bon/cad

MTPJ cheilectomy - not 1st 0 3 5 bon/cad

Soft tissue procedures

Excision of Morton's neuroma 0 3 5 cad

Fifth toe soft tissue correction 0 3 5 cad

Lesser toe tenotomy 0 3 5 cad

Plantar fascia release 0 3 5 cad

Tendon decompression or repair 0 3 5 cad

Tendon transfer foot 0 3 5 cad

Tibialis posterior reconstruction 0 3 5 cad

Talectomy 0 2 5 cad

Wedge tarsectomy 0 2 5 cad


Applied Clinical Skills: Children’s Trauma and Orthopaedics

A trainee must be able to demonstrate their competence in the procedures below at the appropriately


Competence Levels



complications


complications

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Trauma Paediatrics

Supracondylar elbow fracture

Supracondylar elbow fracture MUA +/- percutaneous wires 1 4 5 PSP/bon

Supracondylar elbow fracture open reduction 0 3 5 bon

Forearm fractures

Manipulation and POP forearm 1 5 5 PSP

Manipulation and K wire forearm 0 4 5 LT/C/bon

Titanium elastic nailing paediatric long bone 0 2 5 bon

Slipped upper femoral epiphysis

Dunn procedure for slipped upper femoral epiphysis 0 2 5 bon/cad

Slipped upper femoral epiphysis percutaneous cannulated screw

fixation 0 2 5

bon/cad

Drainage of septic arthritis of the hip 0 2 5 cad (adult)

Repair of avulsion of tibial eminence 0 2 5 bon

ORIF paediatric ankle fracture 0 4 5 bon

Obstetric brachial plexus injury: exploration / repair / grafting 0 1 2 cad (adult)

Elective Paediatrics

Cerebral Palsy

Adductor tenotomy - hip 0 2 5 cad (adult)

Botulinum toxin injection - musculoskeletal 0 2 5 LT/C

Hamstring lengthening 0 2 5 cad (adult)

Iliopsoas release / lengthening 0 2 5 cad (adult)

MTPJ arthrodesis 0 2 5 bon

Patella realignment 0 2 5 bon

Steindler's release 0 1 5 cad (adult)

Tendo-achilles lengthening 0 2 5 bon

Tendon transfer foot 0 1 5 cad (adult)

Tendon transfer not hand / foot 0 1 5 cad (adult)


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CTEV correction

Arthrodesis for recurrence for CTEV 0 1 5 bon

Bony release for recurrence for CTEV 0 1 5 cad (adult)

CTEV correction 0 1 5 bon/cad

Ilizarov correction for CTEV 0 1 5 bon

Percutaneous tendo-achilles release for CTEV 0 2 5 cad (adult)

Posterior release for CTEV 0 1 5 cad (adult)

Postero-medial release for CTEV 0 1 5 cad (adult)

Soft tissue release for recurrence for CTEV 0 1 5 cad (adult)

Tibilialis anterior transfer for CTEV 0 1 5 cad (adult)

DDH

Application of hip spica 0 2 5 LT/C

Hip MUA 0 2 5 PSP

Open reduction for DDH 0 1 5 bon/cad

Osteotomy hip - pelvic for DDH 0 1 5 bon/cad

Osteotomy hip - proximal femoral for DDH 0 1 5 bon/cad

Distraction lengthening of bone upper limb 0 1 5 bon/cad

Excision of physeal bar (Langenskjold procedure) 0 1 5 bon/cad

Femoral lengthening 0 1 5 bon/cad

GA change of POP 0 3 5 bon/cad/equ

Repair of avulsion of tibial eminence (child) 0 2 5 bon/cad

Sternomastoid release (torticollis) 0 1 5 bon/cad

Tibial lengthening 0 1 5 bon/cad

Documents

Trauma & Orthopaedic Curriculum Mapped to Simulation Options